Discussion in 'Parents of Children with Type 1' started by Beach bum, Mar 19, 2015.
Kind of an incomplete analysis with just a bit of bias.
The article briefly mentions that the demand for older cheaper insulin would keep the cost down and that a group in canada succesfully demanded the older insulin but fails to mention why patients in the United States are not demanding the older insulin in enough quantity to make it profitable for drug companies to make it.
Yes doctors are promoting the newer insulins but still why are patients who can't afford the new stuff not creating a market for the old stuff? Two theories: 1) everyone wants the new stuff even if it does cost more 2) too few people can't afford the new stuff.
The idea that a large number of people would want the old stuff and would pay for it is not supported by the article.
I don't buy any of that story one bit. It doesn't explain is why you can buy a vial of Humalog from a Canadian pharmacy for $44.99 and the same vial in the US is $213!! It all comes from the same place. Either we are subsidizing the rest of the world or there is a ton of profit taking here, or both.
This is contradictory:
"In government-funded studies that have compared older drugs to newer drugs, often older drugs come out looking better or equal to newer drugs," Fugh-Berman says.
Then it says,
"Greene says innovations in insulin over the past 90 years have been significant."
So clearly the older insulin isn't better or as good as newer versions.
Then it asks, "Do these innovations merit the loss of affordable insulin?"
But it doesn't prove that the innovations are the cause of the price increase.
I thought there were a lot of assumptions made. A lot of "probably" and "surely" type opinion statements. It seemed like they weren't telling the whole story.
And I wonder what PETA would have to say about going back to animal derived insulin. Doubt that would go over well.
I, too, wonder why insulin is so expensive in the US. A lot of health care items cost more than they should. It's not limited to insulin, and it's not about doctors falling for marketing schemes. But I really don't have a good explanation.
It also seems to downplay the benefit of a 40% drop in prices of possible generics. It may not be 80% but it still is significant for those who can't afford it now. Instead, they are 'concerned' that it will be only 40%. That seems odd to me.
Interesting to think about. Thanks for sharing.
This is another good article that mentions the idea of "evergreening." Basically pharmaceutical companies make tiny changes in drugs in order to extend the lifespan of their patent. There was a really good documentary, I believe on PBS from a few years ago that goes into this in detail. Also not sure if anyone else has been following the lawsuit between Sanofi and Eli Lilly over generic lantus (the patent on lantus expired last month but due to a lawsuit that may not even have any merit Eli Lilly can't market their generic lantus). My personal belief is that the FDA needs to do whatever it takes to get generic insulin on the market and not allow big pharma to manipulate the legal system to maximize their profits. If anyone is super curious about this topic, the "battle" to develop and market generic revlimid is another example of a pharmaceutical company using the legal system to block the development of a generic drug.
There is a serious love hate relationship we have with pharmaceutical companies.
We love them when they invest billions to bring new products to market (afrezza and hopefully smart insulin), we hate them when they play games with the legal system to protect lucrative patents (examples a plenty in this thread), we love them when they create new drugs to cure exotic diseases, we hate them when they don't make them available during development stages to critically ill people.
It is such a strange relationship we have.
I completely agree with you.
indicates that rxcanada4less may offer subquality products which might explain the price that is more than half of what another canadian pharmacy is selling insulin for.
Last time I brought apidra in Canada (Montreal) the cost was $24 in CDN. It was a few years ago but that was about 15% of the cost of the exact same vial in the US. I was just out with a friend and realized my pump was out of insulin and instead of going back to the hotel I just bought a vial at a local pharmacy.
I have no idea how much insulin costs in the U.S and in Canada a few years ago. Would someone like to show us side by side how much the exact same insulin costs right now in the U.S. and in Canada.
Theories for what could account for a price difference: It could be that in Canada the government subsidizes the cost of certain drugs passing some of the costs onto taxpayers. It is also possible that U.S. congressmen make deals with U.S drug companies to make the costs artificially high in exchange for campaign contributions. It is also possible that U.S companies are charging more here than there as indicated in post #3.
The current price for a vial of humalog from a canadian pharmacy is $32 (which is actually $25.42 USD considering the current exchange rate). The current cash price from my local target is $280, the insurance negotiated price is $216. So the price in the US is about 10x the price in Canada.
Here is a link for a diabetes pharmacy in Ontario.
1 vial of Novolog from Shopper's Drug Mart (one of Canada's standard drug stores like CVS or Walgreen's--not shady or questionable in any way) cost me CAD $35.02 last month--and Meg is right: that's a lot less in USD with the current exchange rate. It's been 9 months since I bought insulin in the US, so I'm not sure what the going rate is there.
Yea, no. The problem is with the insurance "plan". I can get Humalog for free if we decide to use it ... Novolog is much more expensive. I can't imagine that a vial of Humalog out of pocket at a pharmacy is $280. I bought a vial of Novolog out of pocket in the US in an emergency situation and it was $180. Bottom line is that the market is messed up. Pharmacies are whacked as well as the manufacturer and the insurance companies don't make it any easier.
I can't tell what you are arguing here. I'm assuming that you don't mean that you can walk into a pharmacy without insurance and get humalog for free. The cost of humalog in the specific town I live in is $280 at target. I paid that several weeks ago. I just used the goodrx app to check and in my zip code the cash cost of a vial of humalog ranges from $217 to $303 depending on pharmacy. Novolog starts at $167 per vial.
Canadian prescription costs are lower because their government impose price caps on medication.
Without a uniform government price cap, each insurance carrier negotiate for itself, Hence the differences in prices and the periodic changes in formulary. The patient without insurance faces the ridiculous "list price". Its not just insulin, ever look at what the "list price" is for simple things like a blood test, an endo visit, or anything medically related ?
I believe the US probably subsidize Canadians relative to the cost of drug development, but I'm not sure a US government pricing boards is the answer. Without the proper profit motive, capital will flow away from new drug research.
A price cap would explain the lower costs. And I agree that a U.S. price cap is not the answer. When we have had price controls on various things disaster was the result - think rent controls or gas lines from the 70's. And this isn't just the U.S. where price controls are disasterous. They have been bad in Russia too where they had bread lines. For every action there is some sort of reaction. If you enact price controls the market will respond so that there is pain in some other area. It is of course hard to predict where the pain will be felt. It appears to me that the various countries of the world that enact price controls are exporting that pain to the United States where we pay more for drugs and R and D to compensate for their lower prices. Should the U.S. ever enact price controls then the pain would shift.
Which is not to say that the countries that have price controls don't feel any pain at all:
"Many critics of the drug industry contend that the quickest, most effective way to ensure Americans have access to affordable prescription drugs is to impose price controls, as many other industrialized nations, including Canada, have done.
While it is true that residents of countries with prescription drug price controls pay less for some drugs, they pay more for others . . . if they can get them at all. For example, an April 1999 comparison of drug costs in several countries by Prof. Patricia M. Danzon of the University of Pennsylvania's Wharton School of Business found that "Canadian prices are between 13 percent lower and 3 percent higher than the U.S., depending on the price index used." Moreover, generic drugs, which make up 45 percent of the American prescription drug market, tend to cost more in Canada than in the U.S.
However, the biggest problem may be access. According to Dr. William McArthur, a Canadian physician and formerly the chief coroner in Vancouver, between 1994 and 1998 the Canadian government considered some 400 new drugs but "ruled that only 24—or 6 percent—were substantial improvements over their predecessors."
In addition, each of the 10 Canadian provinces has a review committee that must approve any new drug for the province's formulary. "Of 99 new drugs approved by the federal government in 1998 and 1999, only 25 were listed on the Ontario formulary," according to Dr. McArthur.
Since Canadians must pay out-of-pocket for unapproved drugs, demand is low, and pharmacies have little incentive to stock them. As a result, many Canadians travel to the U.S., paying out-of-pocket to get the drugs they need."
IMO the solution is to have the least distortion possible in the market which would result in the lowest prices for the most people.
I stand corrected ... I just called my CVS for retail pricing and it was:
and what I meant by "free" is that, with our insurance(s), Humalog was no copay and Novolog has always been a premium copay. I still maintain that the insurance companies negotiate their prices and that the cost to consumers vary by plan even within the same insurance company. The pharmacist that sold me the Novolog just last year charged me his price of $180. So, I was wrong thinking that Humalog retail pricing was way cheaper than Novolog.
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